Hair loss, hair thinning and cancer drugs
Cancer drugs can cause hair loss or hair thinning. But there are things that you can do to help you cope.
About hair loss or hair thinning
Hair loss is one of the most well known side effects of cancer treatment. For many people losing their hair can be distressing and devastating.
It can be a constant reminder of your cancer and what you’re going through. But most people's hair will grow back once treatment has finished.
Cancer drugs can cause:
- mild thinning of your hair
- partial hair loss, or loss of patches of hair
- complete hair loss (alopecia)
Chemotherapy is the type of cancer drug treatment most likely to cause hair loss.
Complete hair loss is very unlikely with any other type of treatment. But some other cancer drugs can cause hair thinning. It is not possible to tell beforehand who will be affected or how badly.
Hair loss also depends on factors such as:
- the type of drug or combination of drugs you are taking
- the dose
- the route (by mouth or as an injection or a drip through a vein)
- how sensitive you are to the drug
- your drug treatment in the past
Drugs that cause hair loss or thinning
Chemotherapy
Most people think that all chemotherapy drugs always cause hair loss. But only some chemotherapy drugs cause hair loss or slight hair thinning.
Chemotherapy drugs that cause hair loss can cause other hair to fall out too. This includes eyelashes, eyebrows, underarm, leg and sometimes pubic hair.
Hair loss is usually gradual rather than sudden. If your hair will fall out, it usually begins within 2 to 3 weeks after treatment starts.
Most people’s hair will grow back once chemotherapy treatment has finished. In very rare cases, the hair does not grow back. This only happens with very high doses of particular drugs. You can ask your doctor or specialist nurse whether your drugs are likely to cause hair loss.
Other cancer therapies
Targeted drugs
Hair loss from targeted drugs varies depending on the type of targeted drug. Hair loss happens gradually. Changes to your hair can also happen during your course of treatment. These include changes such as:
- the texture of your hair
- how dense your hair grows
- the colour
- how quickly it grows back
- eyelashes growing longer, thicker, and darker in colour
Hormone therapy
Hormone therapy usually causes hair thinning. Hair loss may start in the first month of treatment and continue until treatment ends years later.
Hormone therapy for prostate cancer doesn’t usually cause hair loss in men.
Immunotherapy
Hair loss from immunotherapy varies depending on the drug. Hair loss may appear within a few weeks or after a year.
When your hair grows back
Chemotherapy
Unless you have had very high doses of particular chemotherapy drugs, your hair will grow back once treatment is over.
There is evidence that in some people, after treatment with a type of chemotherapy called docetaxel, hair might take much longer to grow back. And that in a few people, hair loss might be permanent. But this is rare and usually depends on the dose you’ve had and for how long you’ve had it. Speak to your doctor or specialist nurse if you are worried about this.
After chemotherapy, it may take several months for your hair to grow back. And your hair is likely to be softer. It might come back a different colour and be more curly. It will probably grow back at the same rate as before chemotherapy.
Your hair should return within 3 to 6 months after your treatment ends. Most people's hair will fully recover within 6 to 12 months.
Other cancer therapies
Thinning hair caused by hormone therapy usually recover, but it may take some time.
Hair usually grows back once treatment with targeted drugs and immunotherapy has finished. With targeted drugs, it can happen even during treatment. With immunotherapy, it may vary.
Your doctor or specialist nurse can tell you more about the risk of hair loss with your type of drug.
Coping with hair loss
These tips can help if you are worried about hair loss or thinning from cancer treatment.
Tips for possible complete hair loss
- Ask about a wig before you start treatment, so you can match the colour and texture of your real hair.
- If you are feeling adventurous, choose a wig for a new look. Why not try the colour and style you've always wanted?
- Think about gradually cutting your hair short before your treatment starts. This might help you get used to seeing yourself with less hair.
- Some people shave their hair off completely to avoid the distress of seeing their hair fall out. Use an electric razor to avoid cutting the skin. Cuts to the skin can be a source of infection.
- Wear a hair net at night so you won't wake up with hair all over your pillow, which can be upsetting.
- Keep your head warm in cooler weather - some people wear a soft hat in bed.
- Rub in oil or moisturiser if your scalp feels dry and itchy, try unperfumed products such as Epaderm, Hydromol or Doublebase.
- Try a moisturising liquid (emollient) instead of soap if your scalp is dry, for example aqueous cream or Oilatum.
- Protect your scalp by covering your head in the sun - your scalp is particularly sensitive to the sun.
Tips for hair loss or thinning
- Use gentle hair products such as baby shampoos or pH neutral shampoo.
- Don't use perms or hair colours on thinning hair. Colours may not take well and perms can damage the hair.
- Use a soft baby brush and comb thinning hair gently.
- Avoid using hair dryers, curling tongs, hair straighteners and curlers on thinning hair and pat your hair dry after washing.
- If your scalp flakes or itches, this means it is dry. Use oil or moisturiser, not dandruff shampoo.
- Protect your scalp by covering your head in the sun.
Covering your head
There are a lot of ways to cover your head if your hair falls out.
A wig is the most obvious choice. But not everyone wants to wear one. They can be a bit hot and itchy, especially in the summer. You can wear a soft inner cap (a wig stocking) under the wig to make it more comfortable. Some people worry that the wig will slip or fall off. You can buy sticky pads designed specifically to keep the wig still.
Some people prefer hats, scarves or baseball caps. Or you can just leave your head uncovered if you feel confident with your bald head.
Ask your nurse if you think you would like a wig. Some people can get a wig on the NHS.
You can wear different types of hats and scarves when you have hair loss or thinning. You can buy these in high street shops or on the Internet.
Ann: Sheena who lost her hair during her chemotherapy will now show you some of the different types of headwear. Hello Sheena.
Sheena: Hello, I wore wigs as well as lots of alternatives. There are many different alternatives to wigs. The stretchy tube is simple, easy and quick to put on. It’s comfortable, light and breathable and there are no uncomfortable seams. And it’s easy to wash. They come in lots and lots of different colours which is really nice so you can match different outfits very easily. You can get them from lots of different high street stores which is very useful.
I use to keep one of these by my front door. So if anyone rang on my front doorbell and I didn’t have my wig on or have my headscarf on I could just pick this up very quickly and just pop it on. It is important to just make sure you adjust it so that it follows your natural hairline. And then that was it. I was ready to go and answer the door. If I then wanted to go out I could then just tuck it in at the back and if I wanted to I could just put an ordinary outdoor hat on top and that would be me ready to go. The other nice thing about that is that if you perhaps were out and somebody invites you in for a coffee, you don’t want to go in wearing an outdoor hat you, so can just slip the outdoor hat off. Make sure you hold your fingers to keep it in place and you have got head covering.
Depending on the shape of your face you might want to create a bit more width and one of the ways to do that is to add another one of these stretchy tubes on top. They are quite versatile. And actually just pop it on, very simple. You can do a little bit of adjusting if you want to, and then it’s created a little bit more width. If you want to create a bit more height if you just un tuck the back bit you can just rearrange it... and tuck the front part under there and that creates a bit more height.
The other thing you can do is to add different scarves and accessories. You can even take... you know this would be quite a good scarf you could just wrap it... around... and it gives you quite a nice elegant look, so you can change it to whatever suits your personality, your wardrobe and what you are doing.
The other important thing if you are talking about scarves is looking at the size um and texture of what they are. This one is a bit too small... that sort of size. It won’t provide enough coverage so when you tie it you’ll find you’ve got sort of gaps and won’t be a good size. The sort of size you are looking for is this sort of one, you can see it’s quite big that’s the sort ideal size of head scarf. This is cotton so it’s got a little bit of grip it’s not going to slide. The problem is this is a really beautiful scarf but this is silk. The trouble with silk is that if you tie it, you think it is secure it tends to slip so it is much better to choose a fabric with just that little bit of grip.
If you want to tie a headscarf it is important to start with something quite simple. You don’t want to start with anything too complicated. You form it into a triangle first, if you create a little turn over it gives you a little bit more height which is quite nice because what you are trying to re create is that sort of volume around your face and that’s what the scarves and the tubes do.
And then it goes round the back and use one of these stretchy bands but without any metal because otherwise it might catch your headscarf and ruin the fabric. Treat it a bit like tying a ponytail. Double the elastic over and you can pull out as much of the fabric as you like at the back. And again with all these scarves the other thing you can do of course is accessorise them. So we can choose something perhaps to just add a little bit of extra... this would work, this would work again. And again you can either tie bows or you can wrap the ends in whatever you feel comfortable doing. If you just lose the ends behind.
So the other thing you can think about is perhaps putting a nice summer hat on top. And again you have got the layer underneath so if you want to stop anywhere you can take the hat off but you can just add another. Quite an elegant look. Also another thing is it is quite important sometimes to avoid the sun and this provides you with a nice shade over your face.
The other option are these crinkle cotton ones. Now these are quite nice, they are quite long. And because it is crinkle cotton it will grip quite nicely. So again what you are doing is off- setting this, so we have got one end longer than the other. So if you just scrumple the ends, cross them over at the back and then that’s secured it. Then if you give it a little bit of a twist and go over the top. And then secure it. If you can try and tie a reef knot at the side it gives a flatter knot which is a nicer look. And then what you can do is either leave the ties loose or you can tie a bow and again you can lose the ends... and wrap the one round the back there. And they do these in a wide range of different colours and designs. So if you are trying to co-ordinate an outfit it is quite easy to find something that will actually work for that.
If you want to go for hats, one of the things you might need to do is to measure your head to get your hat size. It is a very simple way of measuring. You just need to take tape measure, the middle of your forehead, round the back and there is a little bump on the back of your head. You are measuring over that little bump. And then you just take the measurement and mine is 55, I think 55 to 56 is about a standard size. That’s centimetres. In old money it’s 21 to 21 1/2 inches.
The high street tend to sell them as standard sort of sizes. So, if you have a smaller head or a larger head you might need to look elsewhere. If it is too big you’ll tend to look swamped in it. If it is too small you’ll feel it is quite insecure and you’ll feel like it is slipping off all the time. So it is important to get the right sort of size. Something like this would be good because you are looking at... something that provides enough coverage. So you need to have something that is going to cover...to the sides and also down to the nape of the neck. And you can see here it has quite pretty detail on this one. And another one... I quite like this one, this is another... nice breathable fabric, no sort of seams to be uncomfortable and again you can see it has got quite a nice detail to the side.
Whatever you choose to wear remember you can experiment with different colours and patterns depending on your outfit and what you will be doing that particular day.
Reducing hair loss from chemotherapy
Your doctor will want to give you the treatment that's most likely to work best in treating your cancer. But sometimes there is a choice of drugs you can have.
Speak to your doctor if you find the thought of losing your hair very upsetting. Your doctor might be able to suggest a treatment that is less likely to cause hair loss. It's worth discussing.
Cold caps (scalp cooling)
Your doctor might also suggest you try a cold cap (also called scalp cooling). This can sometimes reduce the amount of hair loss.
You wear a cold cap to lower the temperature of your scalp. This reduces the blood flow in the scalp. And this lowers the amount of drug reaching the hair follicles on your head. With less of the cancer drugs getting to the hair follicles, the hair is less likely to die off and fall out.
Problems with cold caps
Scalp cooling only blocks certain chemotherapy drugs and doesn't work for everyone. So you might still have hair thinning or lose your hair completely. You can't tell whether it will work for you until you try it.
Doctors can’t use scalp cooling for all types of cancer. You can't have scalp cooling if there is a risk of high levels of circulating cancer cells in your scalp blood vessels. This is because the cells in these blood vessels might survive the treatment.
So, scalp cooling isn't usually suitable for people:
- with cancers such as leukaemia and lymphoma
- who are due to have radiotherapy to their scalp
Scalp cooling is also not suitable for people with the following conditions:
- cryoglobulinemia
- posttraumatic cold dystrophy
- cold agglutinin disease
You can't have scalp cooling when undergoing continuous chemotherapy through a pump or chemotherapy tablets. This is because you would need to wear a cold cap 24 hours a day.
Some people worry their cancer might spread to the scalp (metastasise) if they’ve used a cold cap during chemotherapy. Researchers did a 
of studies in 2018. The review showed a very small risk of cancer spreading to the scalp after using a cold cap.
How you have it
You have to spend longer at the hospital having your treatment if you have scalp cooling. You need to wear the cold cap for 30 minutes before you have your drugs. So bring something to distract you, such as a book to read or a film to watch.
It might make you feel cold all over. Wear a jumper or ask for a blanket. Hot drinks will help you feel warmer. Some people find that the cold cap gives them a headache. You can take paracetamol if you find it painful.
You have to continue wearing the cold cap for some time afterwards. This can be between 20 to 90 minutes. The time you need to wear it will depend on what type of chemotherapy drug you’ve had.
Ask your specialist nurse if wearing a cold cap during chemotherapy is suitable for you. If you're worried, you can discuss the possible risks with your specialist nurse.
Patient stories on hair loss and thinning
People react differently to cancer drugs. Here are some stories from cancer patients:
"My hair started to fall out 2 weeks after my first chemotherapy session. As soon as I noticed a few strands coming out, I had my hair cut very short. A few days later it all started to come out and I shaved the rest off.
As a man it doesn't really bother me and my wife quite likes my bald head. Still I'm looking forward to it growing back."
"My doctor said my hair would gradually thin, so I was expecting it. However, I was a bit frightened when it started to come out in handfuls when I washed my hair. So I had my hair cut in a short style to suit thin hair.
When I was in hospital the nurses organised for the wig lady to visit. She was very friendly and helped me choose a wig similar to my own colour and style. I was nervous when my daughter came to see me but she said she could hardly tell the difference. I thought it was a lot greyer than my real colour but my daughter thought it was a perfect match!
I don't wear it all the time. I usually wear a scarf round my head but I like wearing my wig when I go out and I feel very comfortable in it."
"My hair took about 6 to 7 months to grow back. At first, it was quite curly, but as it grew, it became heavier and the curls dropped out."
